| NPI | 1164100558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MO 2025010618) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH61587925) |
| 101YP2500X Counselor, Professional (Licence: MO 2023022520) | |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-07-01 |